I was on a neurology placement at a stroke unit and I had this issue with the FCE and CCT having different opinions on treatment techniques. Something as basic as a transfer for a hemiplegic patient, the FCE suggested to do a 2xA front/back slideboard transfer and the CCT had strong opinion on doing an “angel” transfer (1xA patient fully passive). The FCE’s explanation was that the patient should be encouraged to as active as possible in the transfer – to use their quads to stand and 2xA to help pivot and support. However, the CCT had different opinion! The CCT explained that you shouldn’t encourage hemiplegic patients to participate in the transfer because that will increase tone, encourage pushing effect etc. Later in that prac I was told that different hospitals had different protocols in the stroke unit. In the hospital I was doing the prac in, the hospital’s protocol was to encourage the patient to be functional as early as possible – ie get them to stand early which differs to another hospital which will hoist transfer the patient for a prolonged period of time (even if they have the ability to stand with assistance). This made me think which “protocol” was better.
I would think functional tasks was more important and this should be encourage and retrained at an early stage. This will also allow the patient to see their improvement functionally and will enhance rehab and increase compliance, but I also understand that with the hoisting issue (I was thinking maybe due to lack of staff and for convenience?) I thought if I had a good rationale of how I did the treatment, then the supervisors will understand where I’m coming from and if I’m comfortable with the technique, then the supervisors should be happy with what I did. I also asked the FCE how I should have dealt with the problem with FCE and CCT doing different techniques for one task. The FCE suggested that if the CCT didn’t accept how things were done at the facility even after I explained to her, then I should do it the CCT’s way when the CCT was at the facility “just to make her happy”. The CCT understood my explanation after a long discussion but I did it the CCT’s way in the end anyway just so I can practice the technique while she was there but I told her that I would have done it the other way because I was more comfortable with it and the CCT was fine with it!
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I have the same problem as well in my current placement! During my first week of placement, I was told different things in treating the same patient by my FCE and CCT. I then did the same as you, changing my treatment depending who was supervising me “just to make them happy” as I could see and understand their rationale in their own treatment choices. In 3rd week, my FCE found out that I was doing my treatment different to hers and I gave her my rationale which my CCT has told me. The FCE then discussed with the CCT to stop confusing me. They both then came to me and told me to stick to what my FCE told me and I felt relieved that my CCT did not take it personally. I learnt that being a physio student, it is quite important to find out our supervisors’ preferences in treatment choices and we should also accept different treatment approaches as long as good rationales are provided.
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